Personal Insurance Checklist

Life today moves fast, and it is vital that we keep in touch so that we can continue to protect you and your family and make sure your insurance coverage gets updated when life changes occur.

Please review the questions below. This Personal Insurance Checklist will allow us to make sure you, your family, and your assets are adequately protected and your insurance policies are as competitive as possible.

Personal Information

Name*

Email*

Phone*

Address

Street AddressAddress Line 2CityStateZIP Code

Best Time to Call

Checklist Questions

Do you have collectibles such as antiques, fine art, stamps, coins, or baseball cards?

Yes

No

Do you own valuable jewelry or furs?

Yes

No

Do you own costly sporting equipment or firearms?

Yes

No

Do you have valuable cameras or other photography equipment?

Yes

No

Do you have any alarms installed in your home?

Yes

No

Describe Alarms

Do you keep more than $100 cash in your home?

Yes

No

Are your personal belongings insured for their full replacement value?

Yes

No

Do you have children away at college?

Yes

No

Do you own tools, equipment, or instruments used in your trade or profession?

Yes

No

Do you operate an office or studio in your home?

Yes

No

Do clients come into your home to make purchases?

Yes

No

Do you baby-sit in your home?

Yes

No

Have you recently remodeled or redecorated your home?

Yes

No

Do you have plans to remodel or redecorate in the future?

Yes

No

If your home suffered an entire loss, would your insurance cover your home's full replacement value?

Yes

No

Are you interested in flood insurance for your home and personal property?

Yes

No

Are you interested in earthquake coverage?

Yes

No

Do you have a wood burning stove?

Yes

No

Do you have a swimming pool?

Yes

No

Do you own rental or investment property?

Yes

No

Do you own a vacation home?

Yes

No

If you rent, do you carry renter's insurance?

Yes

No

Do you plan to purchase a new vehicle this year?

Yes

No

List Potential Vehicles for New Purchase

Would you like us to provide you with an insurance estimate on the vehicle(s) you are considering?

Yes

No

Does our agency insure all of your vehicles?

Yes

No

Does your automobile policy specify by name all of the drivers in your household?

Yes

No

Do you routinely use vehicles you do not own?

Yes

No

Do you have non-factory installed equipment, such as car phones, stereos, or CD players in your automobiles?

Yes

No

Do you store CD's or cassette tapes in your car?

Yes

No

Do you own a vehicle with custom furnishings or equipment?

Yes

No

If your vehicle were in an accident, would your current automobile insurance reimburse you for a rental vehicle while yours is being repaired?

Yes

No

Do you own any of the following?

Camper

Moped

Golf Cart

RV/Motor Home

All-Terrain Vehicle

Boat or Personal Watercraft

Other

Other (Please Describe)

Do you carry at least a one-million-dollar umbrella liability policy?

Yes

No

Do you own a business?

Yes

No

Do we currently insure your business?

Yes

No

Do you plan to start a business?

Yes

No

Would you like a no-obligation review of your life insurance needs for your business?

Yes

No

Do you have sufficient liability or malpractice coverage?

Yes

No

Do you and your family have proper health insurance coverage?

Yes

No

Do you have disability income insurance?

Yes

No

Do other family members need such coverage?

Yes

No

Do you have life insurance which pays your mortgage in case of your death?

Yes

No

Are you insured for long-term supervised health care?

Yes

No

Do you know anyone else who could benefit from a no obligation insurance review from our agency?